Provider Demographics
NPI:1942866207
Name:MANHAS, JANISHA KAUR (MB, BCH, BAO)
Entity Type:Individual
Prefix:MS
First Name:JANISHA
Middle Name:KAUR
Last Name:MANHAS
Suffix:
Gender:F
Credentials:MB, BCH, BAO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6600 EXCELSIOR BLVD
Mailing Address - Street 2:SUITE 160
Mailing Address - City:ST. LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55426
Mailing Address - Country:US
Mailing Address - Phone:952-993-7711
Mailing Address - Fax:
Practice Address - Street 1:6600 EXCELSIOR BOULEVARD
Practice Address - Street 2:SUITE 160
Practice Address - City:ST. LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55426-4744
Practice Address - Country:US
Practice Address - Phone:952-993-7705
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-13
Last Update Date:2020-07-24
Deactivation Date:2020-01-13
Deactivation Code:
Reactivation Date:2020-07-23
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program